Healthcare Provider Details

I. General information

NPI: 1740707462
Provider Name (Legal Business Name): 14TH AVENUE DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 CEDARWOOD CT SE
ALBANY OR
97322-6994
US

IV. Provider business mailing address

1025 BAIN ST SE STE B
ALBANY OR
97322-5247
US

V. Phone/Fax

Practice location:
  • Phone: 541-926-1303
  • Fax:
Mailing address:
  • Phone: 541-926-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN JAMES
Title or Position: OWNER
Credential: DDS
Phone: 541-666-6091